The immune system of people living with HIV/AIDS (PLWHA) can be severely damaged. This decrease in the immune system causes people living with HIV to often experience a number of serious illnesses due to opportunistic infections (IO). Generally, OI will become more severe when the CD4 count falls below 200 cells/mm3 of blood. With the discipline of prevention, treatment and regular laboratory tests, complications due to OI can be avoided.



The best way to prevent OI is to take anti-HIV drugs regularly, so that the immune system is always protected.

In addition, other preventive measures are needed, such as:

Prevent exposure to other sexually transmitted diseases
Do not share in the use of needles, cutlery and other personal equipment
Limiting exposure to possible infections, including tuberculosis, germs in feces, saliva or germs on animal skin
Do not eat uncooked foods, including undercooked eggs, raw milk, cheese, unpasteurized fruit juices and raw vegetables.
Do not drink untreated water, including drinking tap water even though it is fit for drinking.
Be aware of possible exposure to OIs at work, at home and on vacation.


Infections that often occur in PLWHA:

Candidiasis
Candidiasis is caused by a yeast infection called Candida. Candidiasis can occur on the skin, nails, and mucous membranes in all parts of the body. People living with HIV often get candidiasis, especially the mouth and vagina. New candidiasis is considered an OI if it causes a severe or persistent infection in the mouth or vagina, or when it progresses to the esophagus or lower respiratory tract, such as the trachea, bronchi and lung tissue.



Invasive cervical cancer
Cervical cancer starts from the cervix (neck of the womb) and can spread (become invasive) to other parts of the body. Cervical cancer can be prevented by having regular cervical examinations.



Cryptococcosis
This disease is caused by a fungal infection Cryptococcus neoformans. This fungus usually enters the body through the respiratory tract and can cause pneumonia.

Cryptococcosis usually affects the lungs and the central nervous system (brain and spinal cord), but can also affect other parts of the body.



Cryptosporidiosis (Crypto)
Cryptosporidiosis is a diarrheal disease caused by a tiny parasite called Cryptosporidium.

Symptoms include abdominal cramps and severe diarrhea that are chronic.



Cystoisosporiasis
Previously known as isosporiasis. This infection is caused by the parasite Cystoisospora belli (formerly known as Isospora belli). Cystoisosporiasis can enter the body through contaminated food or water.

Symptoms include diarrhea, fever, headache, abdominal pain, vomiting, and weight loss.



Cytomegalovirus (CMV)
CMV can infect several parts of the body and cause vision-threatening pneumonia, gastroenteritis, encephalitis, and retinitis.

People with CMV retinitis will experience progressive visual impairment. CMV retinitis is a medical emergency because it can cause blindness.



Encephalopathy due to HIV
Encephalopathy can occur in both acute and chronic HIV infection. The exact cause is unknown, but it is thought to be due to infection of the brain by HIV and the inflammatory reaction it causes.



Herpes simplex virus (HSV)
HSV is a virus that generally doesn't cause much of a problem for most people. HSV is transmitted through sexual contact or from mother to baby at birth. In normal people with normal immune systems, HSV is latent (inactive). Stress, trauma, other infections, or a weakened immune system (as in people living with HIV) can activate the latent virus and cause symptoms. HSV infection can cause small, watery bubbles in or around the mouth that are painful, or painful ulcers on or around the genitals or anus.

In PLWHA this virus can cause infection in the bronchi, lungs (pneumonia), and esophagus (esophagitis).



Histoplasmosis
Histoplasmosis is caused by the fungus Histoplasma. Histoplasm often develops in the lungs and causes symptoms similar to those of the flu or pneumonia.

In PLWHA whose immune system is very weak, this disease can last a long time and spread throughout the body. This condition is called progressive disseminated histoplasmosis.



Kaposi's sarcoma (SK)
SK is caused by a virus called Kaposi's sarcoma herpes virus (KSHV) or human herpes virus 8 (HHV-8). SK causes small blood vessels to grow abnormally and can appear anywhere in the body. Abnormalities that appear in the form of patches on the skin that are clearly demarcated pink or purple with thickening or can also be flat. SK can be life-threatening if it attacks internal organs, such as the lungs, lymph nodes, or intestines.



Lymphoma
Lymphoma refers to cancer of the lymph nodes and lymphatic tissue d other. There are many types of lymphoma, but several types are associated with HIV, such as non-Hodgkin's lymphoma and Hodgkin's lymphoma.



Tuberculosis (TB)
TB is caused by a bacterium called Mycobacterium tuberculosis. TB can spread through the air when a person with TB coughs, sneezes, or talks. PLWHA who inhale the bacteria can contract pulmonary tuberculosis.

Symptoms of pulmonary tuberculosis include cough, fatigue, weight loss, fever, and night sweats.



Mycobacterium avium complex (MAC)
MAC is caused by infection with various types of mycobacteria:

- Mycobacterium avium

- Mycobacterium intracellulare

- Mycobacterium kansasii.

These bacteria live in our environment, including in soil and dust particles. MAC infection can spread throughout the body and be life-threatening for people with weakened immune systems, such as people living with HIV.



Pneumocystis pneumonia (PCP)
PCP is a lung infection caused by the fungus Pneumocystis jirovecii. PCP occurs in people with weakened immune systems, including people living with HIV.

The first signs of infection include shortness of breath, high fever, and dry cough.



pneumonia
Pneumonia is an infection of one or both lungs. Many microorganisms, including bacteria, viruses, and fungi, cause pneumonia.

Symptoms include cough (with mucus), fever, chills, and difficulty breathing. The most common cause of pneumonia and often life-threatening for people living with HIV is Streptococcus pneumoniae, also known as Pneumococcus. Therefore, it is recommended that PLWHA receive a vaccine against Streptococcus pneumoniae.

Progressive multifocal leukoencephalopathy
This rare brain and spinal cord disease is caused by the JC (John Cunningham) virus. This disease is seen almost exclusively in people living with HIV because their immune systems have been damaged by HIV.

Symptoms include loss of muscle control, paralysis, blindness, speech problems, and altered mental state. The disease often progresses progressively and is fatal.



salmonella septicemia
Salmonella enters the body through contaminated food or water. Salmonella infection (salmonellosis) can affect anyone with symptoms of nausea, vomiting, and diarrhea. Salmonella septicemia that occurs in people living with HIV is a severe form of infection that occurs because bacteria circulate throughout the body due to a weak immune system.



Toxoplasmosis
This infection is caused by the parasite Toxoplasma gondii. Parasites are carried by warm-blooded animals including cats, rodents, and birds, and then transmitted to humans through feces (feces). Transmission occurs when inhaling dust or eating food contaminated with parasites. Toxoplasma can be found in commercial meat, especially red meat and pork, but rarely in poultry.

Infection can occur in the lungs, retina of the eye, heart, pancreas, liver, large intestine, testes, and brain.



In people living with HIV, it is also known as wasting syndrome due to HIV, which is weight loss of more than 10% due to diarrhea, weakness and fever that lasts more than 30 days. Wasting occurs due to loss of muscle mass, although some of the weight loss can also result from fat loss. This syndrome mainly occurs due to opportunistic infections.



Author : dr. Tony Iman, Sp.PK, MARS (Doctor in Charge of PRAMITA Clinical Laboratory Jl. Kelapa Dua Raya No. 18 Jakarta)